Supportive Care in Cancer

, Volume 26, Issue 2, pp 597–603 | Cite as

Patient and provider perceptions of Internet-delivered cognitive behavior therapy for recent cancer survivors

  • Nicole M. AlbertsEmail author
  • Heather D. Hadjistavropoulos
  • Nickolai Titov
  • Blake F. Dear
Original Article



Although most cancer survivors adjust well, a subset experiences clinical levels of anxiety and depression following cancer treatment. Internet-delivered cognitive behavior therapy (iCBT) is a promising intervention for symptoms of anxiety and depression among survivors; however, patient and provider perceptions of iCBT have not been examined.


We employed an exploratory qualitative method and conducted semi-structured interviews with 13 cancer survivors and 10 providers to examine iCBT strengths and weaknesses, areas for improvement, and perceived barriers to program completion. A thematic content analysis approach was used to analyze the data.


The majority of survivors liked the flexible, convenient, and private nature of the program. Many viewed the program as helping them feel less alone following cancer treatment. Areas of improvement included suggestions of additional information regarding cancer treatment side effects. Barriers to completing the program were identified by a minority of survivors and included finding time to complete the program and current symptoms. Providers liked the program’s accessibility and its ability to provide support to patients after cancer treatment. All providers perceived the program as useful in their current work with survivors. Concerns around the fit of the program (e.g., for particular patients) were expressed by a minority of providers.


Results provide additional evidence for the acceptability of an iCBT program among recent cancer survivors and providers in oncology settings. The current study highlights the value of research exploring iCBT for cancer survivors and provides insights for other groups considering Internet-delivered care for survivors.


Cancer Cognitive behavior therapy Internet-delivered Survivorship Anxiety Depression 



We are grateful to all of the cancer survivors and providers for their time and insights that made this study possible. At the time that this research was conducted, the first author, Dr. Nicole Alberts, was funded by a Frederick Banting and Charles Best Canada Graduate Scholarship—Doctoral Award from the Canadian Institutes of Health Research, Ottawa, ON, Canada.

Compliance with ethical standards

The study was approved by the Human Research Ethics Committees, and the component involving survivor interviews was registered, in conjunction with the feasibility trial, with the Current Controlled Trials Register (ISRCTN60887190).

Conflict of interest

Dr. Alberts and the co-authors, Drs. Hadjistavropoulos, Titov, and Dear do not have any interests that might be interpreted as influencing the current study. At the time that this research was conducted, the first author, Dr. Alberts, was funded by a Frederick Banting and Charles Best Canada Graduate Scholarship—Doctoral Award from the Canadian Institutes of Health Research, Ottawa, ON, Canada. Dr. Alberts does not have a financial relationship with the Canadian Institutes of Health Research. Dr. Alberts has full control of all primary data and agrees to allow Supportive Care in Cancer to review the data if requested.


  1. 1.
    Boyes AW, Girgis A, Zucca AC, Lecathelinais C (2009) Anxiety and depression among long-term survivors of cancer in Australia: results of a population-based survey. Med J Aust 190(7 Suppl):S94–S98PubMedGoogle Scholar
  2. 2.
    Mei Hsien CC, Wan Azman WA, Md Yusof M, Ho GF, Krupat E (2012) Discrepancy in patient-rated and oncologist-rated performance status on depression and anxiety in cancer: a prospective study protocol. BMJ Open 2 (5). doi:
  3. 3.
    Prieto JM, Atala J, Blanch J, Carreras E, Rovira M, Cirera E, Espinal A, Gasto C (2005) Role of depression as a predictor of mortality among cancer patients after stem-cell transplantation. J Clin Oncol: Off J Am Soc Clin Oncol 23(25):6063–6071. CrossRefGoogle Scholar
  4. 4.
    Osborn RL, Demoncada AC, Feuerstein M (2006) Psychosocial interventions for depression, anxiety, and quality of life in cancer survivors: meta-analyses. Int J Psychiatry Med 36(1):13–34CrossRefPubMedGoogle Scholar
  5. 5.
    Muriel AC, Hwang VS, Kornblith A, Greer J, Greenberg DB, Temel J, Schapira L, Pirl W (2009) Management of psychosocial distress by oncologists. Psychiatr Serv (Washington, DC) 60(8):1132–1134. CrossRefGoogle Scholar
  6. 6.
    Hedman E, Ljotsson B, Lindefors N (2012) Cognitive behavior therapy via the Internet: a systematic review of applications, clinical efficacy and cost-effectiveness. Expert Rev Pharmacoecon Outcomes Res 12(6):745–764. CrossRefPubMedGoogle Scholar
  7. 7.
    Ritterband LM, Bailey ET, Thorndike FP, Lord HR, Farrell-Carnahan L, Baum LD (2012) Initial evaluation of an Internet intervention to improve the sleep of cancer survivors with insomnia. Psycho-Oncology 21(7):695–705. CrossRefPubMedGoogle Scholar
  8. 8.
    Wootten AC, Abbott J-AM, Meyer D, Chisholm K, Austin DW, Klein B, McCabe M, Murphy DG, Costello AJ (2015) Preliminary results of a randomised controlled trial of an online psychological intervention to reduce distress in men treated for localised prostate cancer. Eur Urol 68(3):471–479. CrossRefPubMedGoogle Scholar
  9. 9.
    Willems RA, Bolman CA, Mesters I, Kanera IM, Beaulen AA, Lechner L (2016) Short-term effectiveness of a web-based tailored intervention for cancer survivors on quality of life, anxiety, depression, and fatigue: randomized controlled trial. Psycho-Oncology.
  10. 10.
    Alberts NM, Hadjistavropoulos HD, Dear BF, Titov N (2017) Internet-delivered cognitive-behaviour therapy for recent cancer survivors: a feasibility trial. Psycho-Oncology 26(1):137–139. CrossRefPubMedGoogle Scholar
  11. 11.
    Kanera IM, Willems RA, Bolman CA, Mesters I, Zambon V, Gijsen BC, Lechner L (2016) Use and appreciation of a tailored self-management eHealth intervention for early cancer survivors: process evaluation of a randomized controlled trial. J Med Internet Res 18(8):e229. CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Rabin C, Simpson N, Morrow K, Pinto B (2013) Intervention format and delivery preferences among young adult cancer survivors. International journal of behavioral medicine 20(2):304–310. CrossRefPubMedGoogle Scholar
  13. 13.
    Trisha G, Glenn R, Fraser M, Bate P, Olivia K (2004) Diffusion of innovations in service organizations: systematic review and recommendations. The Milbank Quarterly 82(4):581–629CrossRefGoogle Scholar
  14. 14.
    Hack TF, Carlson L, Butler L, Degner LF, Jakulj F, Pickles T, Dean Ruether J, Weir L (2011) Facilitating the implementation of empirically valid interventions in psychosocial oncology and supportive care. Support Care Cancer 19(8):1097–1105. CrossRefPubMedGoogle Scholar
  15. 15.
    Perle JG, Langsam LC, Randel A, Lutchman S, Levine AB, Odland AP, Nierenberg B, Marker CD (2013) Attitudes toward psychological telehealth: current and future clinical psychologists’ opinions of Internet-based interventions. J Clin Psychol 69(1):100–113. CrossRefPubMedGoogle Scholar
  16. 16.
    Vigerland S, Ljótsson B, Bergdahl Gustafsson F, Hagert S, Thulin U, Andersson G, Serlachius E (2014) Attitudes towards the use of computerized cognitive behavior therapy (cCBT) with children and adolescents: a survey among Swedish mental health professionals. Internet Interventions 1(3):111–117. CrossRefGoogle Scholar
  17. 17.
    Sinclair C, Holloway K, Riley G, Auret K (2013) Online mental health resources in rural Australia: clinician perceptions of acceptability. J Med Internet Res 15(9):e193. CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Stallard P, Richardson T, Velleman S (2010) Clinicians’ attitudes towards the use of computerized cognitive behaviour therapy (cCBT) with children and adolescents. Behav Cogn Psychother 38(5):545–560. CrossRefPubMedGoogle Scholar
  19. 19.
    Gun SY, Titov N, Andrews G (2011) Acceptability of Internet treatment of anxiety and depression. Australasian Psychiatry 19(3):259–264. CrossRefPubMedGoogle Scholar
  20. 20.
    Waller R, Gilbody S (2009) Barriers to the uptake of computerized cognitive behavioural therapy: a systematic review of the quantitative and qualitative evidence. Psychol Med 39(5):705–712. CrossRefPubMedGoogle Scholar
  21. 21.
    Donovan CL, Poole C, Boyes N, Redgate J, March S (2015) Australian mental health worker attitudes towards cCBT: what is the role of knowledge? Are there differences? Can we change them? Internet Interventions 2(4):372–381. CrossRefGoogle Scholar
  22. 22.
    Herschell AD, Kogan JN, Celedonia KL, Gavin JG, Stein BD (2009) Understanding community mental health administrators’ perspectives on dialectical behavior therapy implementation. Psychiatric services (Washington, DC) 60(7):989–992. CrossRefGoogle Scholar
  23. 23.
    Hsieh HF, Shannon SE (2005) Three approaches to qualitative content analysis. Qual Health Res 15(9):1277–1288. CrossRefPubMedGoogle Scholar
  24. 24.
    Auerbach CFS, L. B. (2003) Qualitative data: an introduction to coding and analysis. NYU Press, New YorkGoogle Scholar
  25. 25.
    Mays N, Pope C (2000) Assessing quality in qualitative research. Br Med J 320(7226):50CrossRefGoogle Scholar
  26. 26.
    Birks M, Chapman Y, Francis K (2008) Memoing in qualitative research probing data and processes. J Res Nurs 13(1):68–75CrossRefGoogle Scholar
  27. 27.
    Holland JC, Kelly BJ, Weinberger MI (2010) Why psychosocial care is difficult to integrate into routine cancer care: stigma is the elephant in the room. J Natl Compr Cancer Netw 8(4):362–366CrossRefGoogle Scholar
  28. 28.
    Husson O, Mols F, Van de Poll-Franse L (2011) The relation between information provision and health-related quality of life, anxiety and depression among cancer survivors: a systematic review. Ann Oncol 22(4):761–772CrossRefPubMedGoogle Scholar
  29. 29.
    Hadjistavropoulos HD, Thompson MJ, Klein B, Austin DW (2012) Dissemination of therapist-assisted internet cognitive behaviour therapy: development and open pilot study of a workshop. Cogn Behav Ther 41(3):230–240CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • Nicole M. Alberts
    • 1
    Email author
  • Heather D. Hadjistavropoulos
    • 2
  • Nickolai Titov
    • 3
  • Blake F. Dear
    • 3
  1. 1.Department of PsychologySt. Jude Children’s Research HospitalMemphisUSA
  2. 2.Department of PsychologyUniversity of ReginaReginaCanada
  3. 3.eCentreClinic, Department of PsychologyMacquarie UniversitySydneyAustralia

Personalised recommendations